Who Gets Breast Cancer and Who Survives?

We're starting to know the answers — and some of them may shock you. Read on to find out if you're at risk.

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After a few decades of focused research and awareness campaigns, it's true that breast cancer isn't the death sentence it used to be — mortality rates in the United States are currently 24 percent lower than they were just 17 years ago, thanks in large part to recent advancements in diagnostic and treatment tools. But along with this influx of knowledge have come some scary realizations: Not only do scientists now know who's most likely to be diagnosed with breast cancer, they can also predict who's most likely not to survive it. Read on for the raw clarity of what we know now about breast cancer.

Young Women Who Get Breast Cancer Are More Likely to Die

Women who are diagnosed with breast cancer before age 40 have slightly poorer prognoses than older women: Their five-year survival rate is about 82 percent, compared with 85 percent among women ages 40 to 74, according to the American Cancer Society (ACS). Why? "Younger women are more likely to have more aggressive tumors," explains Lisa Carey, M.D., medical director of the University of North Carolina Breast Center.

Younger women also tend to have denser breast tissue, which makes it harder for mammograms to detect tumors. That said, these women usually don't get annual mammograms (the ACS recommends yearly screenings beginning at 40), so cases often aren't caught until the woman herself notices a lump — by which time the cancer is often more advanced. Even then, she's likely to be blown off by her physician. "It's common for a 28-year-old to show her doctor a lump, only to have him say, 'You're too young to have breast cancer,'" warns Lillie Shockney, administrative director of the Johns Hopkins Avon Foundation Breast Center.

While you can't control the age at which breast cancer strikes, you can take steps to up your odds of diagnosing it early, which in turn ups your odds of beating it. For starters, if you have a family history of the disease, begin screening 10 years earlier than the age at which your relative was diagnosed, says Shockney. If possible, go to a facility that offers digital mammography, which has higher detection rates than standard mammography in women under age 50, according to the National Cancer Institute (NCI). If you have a strong family history of the disease — two or more first-degree family members, like your mom or sister, have been diagnosed — ask your doctor about more specific diagnostic tests like BRCA gene testing, which looks for hereditary gene mutations that are linked with breast cancer. And know that even if you don't have breast cancer in your immediate family, you may still be at risk if you have relatives with hormone-driven cancers like prostate or ovarian cancer, which are also linked to BRCA gene mutations.

Regardless of your age or family history, have an annual clinical breast exam and take note of any changes in the feel of your breasts. If you do find a lump, don't panic — about 80 percent of biopsied breast lumps are benign. But do call your ob/gyn right away to discuss further testing. And if he says you're too young to worry, tell him you're too young not to — and find another doctor.

Overall breast cancer survival rates may have improved, but not among minority women: In fact, three minority groups — African-American, Native American, and Hispanic women — are all up to 70 percent more likely to die after a diagnosis than Caucasian women, according to a study at the Fred Hutchinson Cancer Research Center in Seattle. One reason is that the most incurable tumor type — triple negative — affects African-American and Hispanic women more than Caucasian women. And it's even more prevalent in young black women, says Carey. Her research shows that 39 percent of premenopausal African-American breast cancer victims have a triple-negative tumor, compared with 14 percent of all non–African-American women at any age. "We're not sure why — it may be genetic," says Carey.

Regardless of their type of cancer, minority women may not be receiving the full treatment they need. One University of Rochester study found that doctors tend to give black women lower doses of chemotherapy than they give to white women. "We believe that physicians aren't even aware that they're doing this," explains study author Jennifer Griggs, M.D. "Other surveys have found that physicians perceive African-American patients as less likely to adhere to medical advice, so they may unconsciously worry that a too-high dose will cause side effects that will discourage patients from coming back."

Minority women's cancers are also often diagnosed at a later stage, likely because they don't seek out crucial diagnostic tests: Only about 43 percent of all African-American women over age 40 reported having a mammogram in the last year, according to one recent study. "I've had minority women come into my office with huge tumors and I've asked them, 'Why didn't you come in earlier?'" says Christine Pellegrino, M.D., an assistant clinical professor at the Albert Einstein College of Medicine in Bronx, NY. "Sometimes they say it's because they didn't have health insurance, or that they're too busy working or taking care of their kids. But by and large, what's really going on is either a lack of awareness and education about breast cancer or, understandably, denial."

Certain Tumors Are Less Treatable Than Others, and Doctors Know Your Odds of Getting Them

Doctors used to rely on staging — the size of the cancer and how far it had spread — to determine prognosis, but they now know that tumor type is even more important. "Different kinds of tumors have different 'personalities,' and each responds differently to treatment," says Eric P. Winer, M.D., director of breast oncology at the Dana-Farber Cancer Institute in Boston. About two thirds of all breast cancer tumors are hormone sensitive, which means they grow in response to estrogen. The good news: Women who have hormone-sensitive tumors have a higher survival rate because these tumors grow more slowly than other types and can often be prevented from recurring with hormone therapy.

Another 20 percent of all breast cancers have small amounts of a protein called human epidermal growth factor receptor 2 (HER2), which promotes tumor growth, says Winer. These HER2-positive tumors traditionally had a poorer prognosis because they tend to spread more quickly, but newer medications lower chances of recurrence.

The last approximately 15 percent of all breast cancer tumors are triple negative. They're more aggressive and more likely to recur than the others, says Winer, and they're also associated with the poorest survival rates.

Nearly Half of Women Don't Get Enough Chemo

Thirty years ago, if you had breast cancer, you got a mastectomy, period. "Even today, when most of my patients learn they have breast cancer, their first impulse is to say, 'Give me a mastectomy so I don't have to worry about it anymore,'" says oncologist Richard Bleicher, M.D., of Fox Chase Cancer Center in Philadelphia. But experts now agree that a more aggressive approach isn't necessarily better for treating early-stage cancer. In fact, a landmark study found that women with stages I and II breast cancer who had a lumpectomy with radiation were just as likely to survive as those who underwent a mastectomy.

Beyond surgery and chemotherapy, any long-term treatment depends on tumor type. For instance, women with early-stage hormone-sensitive cancers often take an anti-estrogen drug like tamoxifen, which reduces chances of recurrence by about half. Drugs like Herceptin and Tykerb are used to treat HER2-positive breast cancers; both work to block the HER2 protein that triggers cancer cell growth. These and other treatments are more successful than ever, but many sufferers aren't reaping the full benefits: A whopping 70 percent of women who had mastectomies were never told that less dramatic surgery, such as lumpectomy, was an option, according to a study commissioned by the American Society of Clinical Oncology. And up to half of all breast cancer patients may have received chemotherapy doses that were lower than the recommended levels.

"To get the best, most up-to-date treatments, make sure that all of the physicians you are seeing are experienced in treating breast cancer, whether it's your surgeon, your oncologist, or the radiation oncologist," says Winer. An option: one of the 64 NCI-designated comprehensive cancer centers across the country — these facilities are often involved in clinical trials and treat large volumes of breast cancer patients. (Find a center near you at cancer.gov.)

Overweight Women Are More Likely to Develop — and Die from — Breast Cancer

Very few of us can boast that we still fit into our high school prom dresses, but if you've gained more than 20 pounds since your 18th birthday, your risk of developing breast cancer is 40 percent higher compared with those who stay within 5 pounds of their teenage weight, research from the ACS shows. Excess pounds also lower your risk of survival: Breast cancer sufferers with a body mass index (BMI, a measure of body fat based on height and weight) of 25 to 29 are 34 percent more likely to die of breast cancer than those at a normal weight, according to a major review from the Hutchinson Center. And obese women (those with a BMI of 30 plus) are 63 percent less likely to survive.

"When you're obese, you have higher insulin levels, which promotes cancerous cell growth," explains review author Anne McTiernan, M.D., director of the Prevention Center at the Hutchinson Center. Another explanation for poor survival rates: Almost 40 percent of severely obese women get a significantly lower dose of chemo than they need, according to research at the University of Rochester. "The heavier you are, the more chemo you need to wipe out cancer — and some physicians are scared to give such massive doses to patients," says Griggs, who authored the study.

However, there is some reassuring news for those who are heavyset: Losing weight at any age can help cut breast cancer risk. Findings in the Journal of the American Medical Association reveal that postmenopausal women who lost 22 pounds were 57 percent less likely to develop the disease compared with those who maintained their weight.

There's been a lot of conflicting research on diet and breast cancer risk, but the latest findings suggest that following a low-fat diet and eating plenty of produce can help prevent the disease. A National Institutes of Health study found that postmenopausal women who got 40 percent of their calories from fat were 11 percent more likely to get breast cancer than women who got 20 percent of their calories from fat. And eating ample fruits, veggies, and whole grains lowered women's risk by 17 percent in one French study.

A low-fat, veggie-rich diet also seems to help prevent breast cancer recurrence. Women with early-stage breast cancer who consumed less than 33 grams of fat daily slashed their odds of recurrence by about 24 percent in one NCI study. And new research found that eating at least five servings of fruits and veggies a day (and getting three hours weekly of moderate exercise) can cut in half your risk of dying from breast cancer.

"We know that a high-fat diet boosts hormones that promote cancer cell growth," explains McTiernan. And a low-fat diet also fends off the extra pounds that boost breast cancer risk. As for fruits and veggies, "the more you eat, the greater your chance of consuming more cancer-fighting antioxidants and phytochemicals," explains Jennifer K. Reilly, R.D., senior nutritionist for The Cancer Project, a nonprofit consumer-education group in Washington, D.C.

Women Who Exercise Are Less Likely to Develop Breast Cancer

Like it or not, exercising regularly is one of the best ways to both prevent breast cancer and survive a diagnosis. And you don't have to expend much energy to get some benefit — just 1.3 hours weekly of moderate activity lowered women's risk of developing the disease by 20 percent in one University of Southern California study. The same goes when it comes to beating the disease: A Harvard University study of almost 3,000 women with breast cancer found that those who did the equivalent of walking just an hour a week at a pace of 2 to 3 mph reduced their risk of death by 20 percent.

Exercise packs a lot of powerful anticancer punches: It reduces levels of circulating estrogen, which feeds hormone-sensitive tumors; it lowers levels of insulin, a hormone linked to recurrence; and it helps you drop the extra pounds that up your risk. Walking is the easiest way to get moving, so consider buying a pedometer: Simply clipping one on has been shown to motivate all women to sneak in more steps each day, and a University of Alberta study found that breast cancer survivors who received a pedometer increased their exercise by almost 90 minutes a week, compared with a 30-minute increase a week among those who didn't get one. So take a step in the right direction for your health.

"I was almost eight months pregnant when my hips started to hurt. I thought it was pregnancy related, but an MRI revealed a mass on my pelvis; within days I learned I had breast cancer that had spread to my liver and bones. My oncology team basically wrote me off — they gave me about a year to live and told me to get my affairs in order. My husband and I cried for about two hours, and then we said, 'All right, let's figure out what to do.'

"About a week later, I delivered my little girl, Jessica, and had my ovaries removed at the same time because my cancer was driven by estrogen. Jessica was 3 pounds, 13 ounces — small, but healthy. Word spread about my disease, and a family friend recommended I see her oncologist at Arlington Cancer Center in Texas. When I met him, he said, 'You're going to be there when your daughter gets married' — that's what I needed to hear. We moved to Arlington while I had a mastectomy and chemotherapy.

"I've been in remission now for almost four years. Yes, I get scared when I think of the future. But while I can't predict whether my cancer will return, I can have hope and live life."

FERNE DIXON, 42

Printing production manager; single; Rochester, NY

Diagnosed in April 2006 with stage II triple-negative breast cancer; stage IIIA in September 2006; stage IV in May 2007

"I first found a lump in my right breast, along with some nipple discharge, while working on a cruise ship in December 2005. The ship's doctor said it was an infection and put me on antibiotics, but after three different treatments didn't work, he suggested that I get a mammogram when we docked. I thought I didn't fit the breast cancer mold — I was young and healthy and had no family history of the disease.

"But my mammogram picked up a mass, and biopsies revealed I had cancer in my breast and lymph node. My oncologist wasn't optimistic. He told me that my cancer was a very aggressive form that he'd seen in a lot of young African-American women like me. He wanted to blast it with the strongest chemotherapy he had, and I said, 'Let's get down to business.'

"I finally finished treatment last January. In April, I started having chest pain. Scans revealed that the cancer was back and had spread to my lungs, lymph nodes, and chest wall. Since then, it has spread to my skin, and I have more and larger tumors; I start chemo again in a few weeks.

"At this point, I'm freaked out. Hopefully this time they'll get it for good, but I think I'll be dealing with this for the rest of my life."

"I found my lump six years ago while shaving under my arms. My first doctor told me it was a benign cyst, but my second doctor sent me to an oncologist, who biopsied the lump. A few days later, she called to tell me it was breast cancer. I was shocked. It made more sense when a couple of weeks later I found out that breast cancer runs in my family: Three great-aunts on my father's side had also had the disease.

"My cancer was only stage I, and I was told I could have a lumpectomy with radiation, but I opted for a mastectomy and breast reconstruction: I just had a really strong urge to cut out the cancer completely. My new breast is the same shape as my other one, but it has no feeling, and I never got around to getting a new nipple — I never felt the need. It doesn't bother me. I'm just proud that I've beaten my cancer, and now I give speeches to educate others about this issue. I was a team captain for the annual Relay for Life fund-raiser, an all-night nationwide relay event that raises money for the American Cancer Society. I feel good about helping others — it's the one positive that's come out of this whole experience."

If you're battling breast cancer — or someone you love is — here are five resources you shouldn't be without.
by REDBOOK writer and breast cancer survivor Gina Shaw

BreastCANCER101
From the moment you're diagnosed, you're deluged with paperwork. The breastCANCER101 10-year planner created by survivor Monica Knoll, helps you organize and understand it all. Order for $29.99 plus shipping and handling from cancer101.org or use the free online version.

The National Breast Cancer Awareness Month Website
This site (nbcam.org) walks you through everything from the baffling jargon of your pathology report to finding clinical trials and getting help to pay for meds.

The Young Survival Coalition A breast cancer diagnosis is devastating at any age, but it can really blindside you when you're under 40. To find support, hook up with the Young Survival Coalition at youngsurvival.org. Their free ResourceLink Guidebook is full of info on local support groups and much more.

Breast Cancer, There & Back
Jami Bernard was diagnosed with breast cancer in 1996, and this "woman to woman guide" was published in 2001, so a few of the treatment-specific details are outdated — but Bernard's wise, warm advice is timeless.

Breastcancer.org
Developed by oncologist Marisa Weiss, M.D., this site has some of the best message boards online. You'll also find live chat rooms, savvy guides to the latest research, and online conferences.